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Plasma levels of von Willebrand factor and fibronectin as markers of persisting endothelial damage in preeclampsia
Citations from the literature/International
Journal of Gynecology & Obstetrics 50 (1995) 217-226
urine: median 317 ngml, range 59.0 to 440.8 vs. median 12.2 n&l, range 2.5 to 61.6,., respectively, p < 0.005). Conclusions: [1] Interleukin-1 receptor antagonist is physiologically present in the fetal, maternal, and amniotic fluid compartments; [2] microbial invasion of the amniotic cavity in the preterm gestation is associatedwith a significant increasein the concentrations of this cytokiae in the fetal and amniotic fluid compartments but not in maternal plasma; [3] fetal urine is a source of amniotic fluid interleukin-1 receptor antagonist; 14) fetal plasma interleukin-1 receptor antagonist concentrations increasewith gestational age; [5] there is a significant effect of fetal gender in amniotic fluid and neonatal urine concentrations of interleukin-1 receptor antagonist. Plasma levelsof voa WlIlebraml factor sod fibrooectin as markers of persMog endolbelial damage in preechmpsia Deng L.; Bremme K.; Hansson L.O.; Blomback M.
223
livery; controlled during pregnancy (n = 90), including women who were hyperthyroid at presentation and euthyroid at delivery; and uncontrolled (n = 57) including women who were hyperthyroid at presentation and delivery. Results: The risk of low birth weight infants was 0.74 (95%confidenceinterval [CI] 0.18-3.08) among controlled women, 2.36 (95% CI 1.36-4.12) amongwomenwho werecontrolled during pregnancy, and 9.24 (95%CI 5.47- 15.6)among women who were uncontrolled during pregnancy compared to the incidence among nonhyperthyroid mothers. The risk of severe preeclampsia was significantly higher (odds ratio 4.74,95% CI 1.14-19.7)among uncontrolled womencomparedwith thosewho were controlled during their pregnancies.Elevated TSH-receptor antibody levels Were not related to preeclampsia.Maternal thioamide therapy did not adversely affect neonatal outcomes. Conclusion: Lack of control of hyperthyroidism significantly increasesthe risk of low birth weight infants and severepreeclampsia.
SWE
OBSTET GYNECOL 19948416(941-945) Objective: To evaluate the levels of von Willebrand factor and Bbronectin as markers for the severity of endothelial cell injury in preeclampsia. Methods: In 63 pregnant women with preeclampsia,the plasma levels of von Willebrand factor and tibronectin were measuredas soon as symptoms were detected, at 5 weeks postpartum, and after lactation. They were also comparedwith levels in 29 normotensivepregnant women. The von Willebrand factor was measured by enzyme-linked immunoassayand flbronectin was measuredusing an automated immunonephelometric method. Results: In preeclampsia, the levels of von Willebrand factor and libronectin were higher than in normal pregnancy samples drawn in the second and third trimesters.The levels of libronectin were still elevated at 5 weekspostpartum in women with severepreeclampsia. Four patients with severepreeclampsiawho were studied frequently had high levels of von Willebrand factor 5 weeks postpartum. Conclusions: The increased maternal plasma levels of von Willebrand factor and Ebronectin indicate that endothelial stimulation is present during preeclampsia.The high libronectin values found even 5 weeksafter delivery, at least in patients with severe preeclampsia, may indicate an ongoing vascular diseasewith increasedrisk for preeelampsiain subsequentpregnancies.
Low birth weight aod preeclampsia h pregoancies complicated by hypedyroidism
Millar L.K.; Wing D.A.; Leung A.S.; Koonings P.P.; Montoro M.N.; Mestman J.H. USA
OBSTET GYNECOL 19948416(946-949) Objective: To determine whether control of hyperthyroidism during pregnancy reducesthe risk of low birth weight infants and severe preeclampsia. Methods: Labor, delivery, and postpartum records of 181 hyperthyroid women were reviewed for maternal and fetal outcomes.Subjectswere separatedinto three groups basedon their thyroid status: controlled (n = 34), including women who were euthyroid at presentation and de-
Eclampsiaia tbe Lhdted Kingdom Douglas K.A.; Redman C.W.G. GBR
BR MED J 199430916966(1395-1400) Objectives- To measurethe incidenceof eclampsia,establish how often it is preceded by signs of pre-eclampsia,document the morbidity associatedwith eclampsia,and determinethe maternal case fatality rates. Design - A prospective, descriptive study of every case of eclampsia in the United Kingdom in 1992.Information was collected from reviews of hospital case notes and questionnaires to general practitioners. Setting-All 279 hospitals in the United Kingdom with a consultant obstetric unit. Results - Obstetricians and midwives notified 582 possible cases,and 383 were confirmed as eclampsia. The national incidenceof eclampsiawas 4.9110000maternities (95% confidence interval 4.5 to 5.4). Most convulsions occurred despite antenatal care (79%) and within one week of the woman’slast visit to a doctor or midwife (85%).Three quarters of first seizuresoccurred in hospital, of which 38% developed before both proteinuria and hypertension had been documented.Forty four percent of casesoccurred postpartum, more than a third (38%) antepartum, and the remainder (18%) intrapartum. Nearly one in 50 women (1.8%)died, and 35%of all women had at least one major complication. The rate of stillbirths and neonatal deaths was 22.2/1000and 34.1/1000, respectively.Preterm eclampsiaoccurredmore commonly antepartum and was associatedwith more maternal complications and fetusesthat were small for gestational age, as well as with higher rates of stillbirth and neonatal mortality. Antepartum eclampsia,which was more likely to occur preterm, was associated with a higher rate of maternal complications and a higher neonatal mortality. Both factors (gestational prematurity and antepartum occurrence)contributed independently to the severity of the outcome.Conclusion - Eclampsia occursin nearly one in 2000maternities in the United Kingdom and is associated with high maternal morbidity and fatality in cases.It may present unheralded by warning signs. Preterm and antenatal eclampsia seemto be particularly severe.
Journal of Gynecology & Obstetrics 50 (1995) 217-226
urine: median 317 ngml, range 59.0 to 440.8 vs. median 12.2 n&l, range 2.5 to 61.6,., respectively, p < 0.005). Conclusions: [1] Interleukin-1 receptor antagonist is physiologically present in the fetal, maternal, and amniotic fluid compartments; [2] microbial invasion of the amniotic cavity in the preterm gestation is associatedwith a significant increasein the concentrations of this cytokiae in the fetal and amniotic fluid compartments but not in maternal plasma; [3] fetal urine is a source of amniotic fluid interleukin-1 receptor antagonist; 14) fetal plasma interleukin-1 receptor antagonist concentrations increasewith gestational age; [5] there is a significant effect of fetal gender in amniotic fluid and neonatal urine concentrations of interleukin-1 receptor antagonist. Plasma levelsof voa WlIlebraml factor sod fibrooectin as markers of persMog endolbelial damage in preechmpsia Deng L.; Bremme K.; Hansson L.O.; Blomback M.
223
livery; controlled during pregnancy (n = 90), including women who were hyperthyroid at presentation and euthyroid at delivery; and uncontrolled (n = 57) including women who were hyperthyroid at presentation and delivery. Results: The risk of low birth weight infants was 0.74 (95%confidenceinterval [CI] 0.18-3.08) among controlled women, 2.36 (95% CI 1.36-4.12) amongwomenwho werecontrolled during pregnancy, and 9.24 (95%CI 5.47- 15.6)among women who were uncontrolled during pregnancy compared to the incidence among nonhyperthyroid mothers. The risk of severe preeclampsia was significantly higher (odds ratio 4.74,95% CI 1.14-19.7)among uncontrolled womencomparedwith thosewho were controlled during their pregnancies.Elevated TSH-receptor antibody levels Were not related to preeclampsia.Maternal thioamide therapy did not adversely affect neonatal outcomes. Conclusion: Lack of control of hyperthyroidism significantly increasesthe risk of low birth weight infants and severepreeclampsia.
SWE
OBSTET GYNECOL 19948416(941-945) Objective: To evaluate the levels of von Willebrand factor and Bbronectin as markers for the severity of endothelial cell injury in preeclampsia. Methods: In 63 pregnant women with preeclampsia,the plasma levels of von Willebrand factor and tibronectin were measuredas soon as symptoms were detected, at 5 weeks postpartum, and after lactation. They were also comparedwith levels in 29 normotensivepregnant women. The von Willebrand factor was measured by enzyme-linked immunoassayand flbronectin was measuredusing an automated immunonephelometric method. Results: In preeclampsia, the levels of von Willebrand factor and libronectin were higher than in normal pregnancy samples drawn in the second and third trimesters.The levels of libronectin were still elevated at 5 weekspostpartum in women with severepreeclampsia. Four patients with severepreeclampsiawho were studied frequently had high levels of von Willebrand factor 5 weeks postpartum. Conclusions: The increased maternal plasma levels of von Willebrand factor and Ebronectin indicate that endothelial stimulation is present during preeclampsia.The high libronectin values found even 5 weeksafter delivery, at least in patients with severe preeclampsia, may indicate an ongoing vascular diseasewith increasedrisk for preeelampsiain subsequentpregnancies.
Low birth weight aod preeclampsia h pregoancies complicated by hypedyroidism
Millar L.K.; Wing D.A.; Leung A.S.; Koonings P.P.; Montoro M.N.; Mestman J.H. USA
OBSTET GYNECOL 19948416(946-949) Objective: To determine whether control of hyperthyroidism during pregnancy reducesthe risk of low birth weight infants and severe preeclampsia. Methods: Labor, delivery, and postpartum records of 181 hyperthyroid women were reviewed for maternal and fetal outcomes.Subjectswere separatedinto three groups basedon their thyroid status: controlled (n = 34), including women who were euthyroid at presentation and de-
Eclampsiaia tbe Lhdted Kingdom Douglas K.A.; Redman C.W.G. GBR
BR MED J 199430916966(1395-1400) Objectives- To measurethe incidenceof eclampsia,establish how often it is preceded by signs of pre-eclampsia,document the morbidity associatedwith eclampsia,and determinethe maternal case fatality rates. Design - A prospective, descriptive study of every case of eclampsia in the United Kingdom in 1992.Information was collected from reviews of hospital case notes and questionnaires to general practitioners. Setting-All 279 hospitals in the United Kingdom with a consultant obstetric unit. Results - Obstetricians and midwives notified 582 possible cases,and 383 were confirmed as eclampsia. The national incidenceof eclampsiawas 4.9110000maternities (95% confidence interval 4.5 to 5.4). Most convulsions occurred despite antenatal care (79%) and within one week of the woman’slast visit to a doctor or midwife (85%).Three quarters of first seizuresoccurred in hospital, of which 38% developed before both proteinuria and hypertension had been documented.Forty four percent of casesoccurred postpartum, more than a third (38%) antepartum, and the remainder (18%) intrapartum. Nearly one in 50 women (1.8%)died, and 35%of all women had at least one major complication. The rate of stillbirths and neonatal deaths was 22.2/1000and 34.1/1000, respectively.Preterm eclampsiaoccurredmore commonly antepartum and was associatedwith more maternal complications and fetusesthat were small for gestational age, as well as with higher rates of stillbirth and neonatal mortality. Antepartum eclampsia,which was more likely to occur preterm, was associated with a higher rate of maternal complications and a higher neonatal mortality. Both factors (gestational prematurity and antepartum occurrence)contributed independently to the severity of the outcome.Conclusion - Eclampsia occursin nearly one in 2000maternities in the United Kingdom and is associated with high maternal morbidity and fatality in cases.It may present unheralded by warning signs. Preterm and antenatal eclampsia seemto be particularly severe.